Introduction

A stillbirth is a baby born dead after 24 completed weeks of pregnancy.

If the baby dies before 24 completed weeks, it's known as a miscarriage or late foetal loss.

Stillbirth is more common than many people think. There are more than 3,600 stillbirths every year in the UK, and one in every 200 births ends in a stillbirth. Eleven babies are stillborn every day in the UK, making it 15 times more common than cot death.

What causes stillbirth?

Around a half of all stillbirths are linked to placental complications. This means that for some reason the placenta (the organ that links the baby's blood supply to the mother's and nourishes the baby in the womb) isn't functioning properly.

About 10% of stillborn babies have some kind of birth defect that contributed to their death. A small percentage of stillbirths are caused by problems with the mother's health, for example pre-eclampsia, or other problems, including cord accidents and infections. 

Read more about causes of stillbirth

What happens when a baby dies in the womb?

If it's suspected that your baby may have died during your pregnancy, a handheld Doppler device or an ultrasound scan can be used to check your baby's heartbeat.

If your baby has died and there's no immediate risk to your health, you'll usually be given time to think about what you want to do next.

You may be able to choose whether you would like to wait for labour to begin naturally, or if you want it to be started with medication (induced).

If your health is at risk, the baby may need to be delivered as soon as possible. It's rare for a stillborn baby to be delivered by caesarean section.

At this stage, it's common for parents to ask why their baby died. Those caring for you may give you some basic information about tests to try to find out why your baby died.

Read more about how stillbirths happen

After a stillbirth

After a stillbirth, many parents want to see and hold their baby. You may also wish to give your baby a name and create memories by taking photographs or a lock of hair. It's completely up to you what you want to do. Decisions about what to do are very personal and there’s no right or wrong way to respond.

Finding out why a stillbirth has happened can be helpful with the grieving process and provide information if you want to get pregnant in the future, so you'll be offered tests to try to find out why your baby died.

By law, all stillborn babies have to be formally registered. In Scotland, this must be done within 21 days of your baby's birth.

A senior doctor will discuss the test results and post-mortem (if you decided to have one) during a follow-up appointment several weeks after the birth. You may also want to discuss any possible effects on future pregnancies.

Read more about what happens after a stillbirth

Help and support

Stillbirth and late miscarriage can be devastating for the baby's parents, and they can also affect wider family members, including children and friends.

You may find it helpful to discuss your feelings with your GP, community midwife or health visitor, or with other parents who've lost a baby.

There are many support groups in the UK for bereaved parents and their families.

Find further information and support around bereavement

Some of these groups are run by parents who've experienced stillbirth, or by healthcare professionals, such as baby loss support workers or specialist midwives.

Read more about stillbirth support 

Can stillbirths be prevented?

Not all stillbirths can be prevented. However, there are some things you can do to reduce your risk of having a stillbirth, such as:

Read more about preventing stillbirth

Information about you

If you have experienced a stillbirth, your clinical team may pass information about you on to the National Congenital Anomaly and Rare Diseases Registration Service (NCARDRS).

This helps scientists to understand more about this complication. You can opt out of the register at any time.

Find out more about the register

Causes

A large proportion of stillbirths seem to happen in otherwise healthy babies and the cause often can't be explained.

However, many stillbirths are linked to placental complications. This means that for some reason the placenta (the organ that links the baby's blood supply to the mother's and nourishes the baby in the womb) isn't functioning properly.

A poorly functioning placenta may be the direct cause of stillbirth, or it may contribute to it because the baby's growth has been held back.

If there have been problems with the placenta, stillborn babies are usually born perfectly formed, though often small. With more research, it's hoped that placental causes may become better understood, leading to better detection of placental problems and better care for these babies.

Other conditions that can cause stillbirth or may be associated with stillbirth include:

  • bleeding (haemorrhage) before or during labour
  • placental abruption – where the placenta separates from the womb before the baby is born (this may be associated with bleeding or abdominal pain)
  • pre-eclampsia – a condition that causes high blood pressure in the mother
  • a problem with the umbilical cord, which attaches the placenta to the baby's tummy button – the cord can slip down through the entrance of the womb before the baby is born (cord prolapse), or it can be wrapped around the baby and become knotted 
  • intrahepatic cholestasis of pregnancy (ICP) or obstetric cholestasis – a liver disorder during pregnancy characterised by severe itching
  • a genetic physical defect in the baby
  • pre-existing diabetes
  • infection in the mother that also affects the baby

Infections

Around one in 10 stillbirths are caused by an infection. The most common type of infection is a bacterial infection that travels from the vagina into the womb (uterus). These bacteria include group B streptococcus, escherichia coli (E.coli), klebsiella, enterococcus, haemophilus influenza, chlamydia, and mycoplasma or ureaplasma.

Some bacterial infections, such as chlamydia and mycoplasma or ureaplasma, which are sexually transmitted infections (STIs), can be prevented using barrier contraception, such as condoms.

Other infections that can cause stillbirths include:  

  • rubella – commonly known as German measles
  • flu – it's recommended that all pregnant women have the seasonal flu vaccine irrespective of their stage of pregnancy
  • parvovirus B19 – this causes slapped cheek syndrome, a common childhood infection that's dangerous for pregnant women
  • coxsackie virus – this can cause hand, foot and mouth disease in humans
  • cytomegalovirus – a common virus spread through bodily fluids, such as saliva or urine, which often causes few symptoms in the mother
  • herpes simplex – the virus that causes cold sores
  • listeriosis – an infection that usually develops after eating food contaminated by bacteria called Listeria monocytogenes (listeria); see preventing stillbirth for more information about the foods to avoid during pregnancy
  • leptospirosis – a bacterial infection spread by animals such as mice and rats
  • Lyme disease – a bacterial infection spread by infected ticks
  • Q fever – a bacterial infection caught from animals such as sheep, goats and cows
  • toxoplasmosis – an infection caused by a parasite found in soil and cat faeces
  • malaria – a serious tropical disease spread by mosquitoes

Increased risk

There are also a number of things that may increase your risk of having a stillborn baby, including:

  • having twins or a multiple pregnancy
  • having a baby who doesn't reach his or her growth potential in the womb
  • being over 35 years of age
  • smoking, drinking alcohol or misusing drugs while pregnant
  • being obese (having a body mass index (BMI) over 30)
  • having a pre-existing physical health condition such as epilepsy

Baby's growth

Your midwife will check the growth and wellbeing of your baby at each antenatal appointment, and they'll plot your baby's growth on a chart to ensure he or she is continuing to grow.

Every baby is different and should grow to the size that's normal for him or her (some babies are naturally small). However, all babies should continue to grow steadily throughout the pregnancy.

If a baby is smaller than expected, or his or her growth pattern tails off as the pregnancy continues, it may be because the placenta isn't working properly. This increases the risk of stillbirth.

Problems with a baby's growth should be picked up during antenatal appointments. However, it's important to be aware of your baby's movements and let your midwife know immediately if you notice a reduction in the baby’s movements.

See preventing stillbirth for more information

How it's confirmed

Your baby's wellbeing will be monitored during your antenatal appointments, so any problems will usually be picked up before labour starts.

If it's suspected that your baby may have died, a midwife or doctor may initially try to listen to the baby’s heartbeat with a handheld Doppler device. An ultrasound scan will also be carried out to check your baby's heartbeat. A doctor will usually be asked to confirm that the baby has died by carrying out an ultrasound scan.

Sometimes, after the baby's death has been confirmed, a mother may still feel her baby moving. This can happen when the mother changes position. In this case the mother may be offered another ultrasound scan.

Finding out your baby has died is devastating. You should be offered support and your options should be explained to you. If you're alone in hospital, ask the staff to contact someone close to you and ask them to come in to be with you.

Read more about getting help after a stillbirth

Giving birth

If a baby dies before labour starts, medication to start labour is usually offered. This is safer for the mother than having a Caesarean section.

If there's no medical reason for the baby to be born straight away, it may be possible to wait for labour to start naturally. This decision doesn't usually need to be made immediately and it may be possible to go home for a day or two first. In some cases, medication that prepares a woman’s body for the induction process may be recommended. This medication can take up to 48 hours to work.

Natural labour

While waiting for labour to begin naturally, regular blood tests are needed after 48 hours.

Waiting for labour to begin naturally also increases the chance of the baby deteriorating in the womb. This can affect how the baby looks when he or she is born, and can make it more difficult to find out what caused the death. 

Induced labour

If the health of the mother is at risk, labour is nearly always induced using medication. This may been done immediately if:

  • the mother has severe pre-eclampsia
  • the mother has a serious infection
  • the bag of water around the baby (the amniotic sac) has broken

Labour can be induced by inserting a pessary tablet or gel into the vagina, or by swallowing a tablet. Sometimes, medication is given through a drip into a vein in the arm.

What happens afterwards

After a stillbirth, most parents want to see and hold their baby. This is entirely up to you. You'll be given some quiet time with your baby if this is what you want.

You can also take photographs of your baby and collect mementos, such as a lock of hair, foot prints or hand prints, or the blanket that your baby was wrapped in at birth.

If you're not sure whether you want to take any mementos of your baby home, it's usually possible for them to be stored with your hospital records. If your hospital doesn't keep paper records, you may be given these mementos in a sealed envelope to store at home. This means you'll be able to look at them if you ever decide you want to.

You may also want to name your baby. However, not everyone does this and, again, it's up to you. Decisions about what to do are very personal and there’s no right or wrong to the way you respond.

Bereavement support

You may be introduced to a bereavement support officer or a bereavement midwife. They usually work in hospitals or for the local council. They can help with any paperwork that needs to be completed and explain choices you can make about your baby's funeral. They'll also act as a point of contact for other healthcare professionals.

Read more about support after a stillbirth

Finding the cause

You'll be offered tests to find the cause of the stillbirth. You don't need to have these, but the results may help avoid problems in any future pregnancies.

The tests you're offered may include:

  • blood tests – these can show whether the mother has pre-eclampsia, obstetric cholestasis, or rarely, diabetes
  • specialist examination of the umbilical cord, membranes and placenta (the tissues that attach you to your baby and support your baby in pregnancy)
  • testing for infection – a sample of urine, blood or cells from the vagina or cervix (neck of the womb) can be tested
  • thyroid function test – to see whether the mother has a condition that affects her thyroid gland
  • genetic tests – to determine whether your baby had problems such as Down’s syndrome; these are usually carried out on a small sample of umbilical cord

More in-depth tests can also be carried out on your baby to try to establish the cause of death, or whether there are any conditions that might have contributed to it. This is called a post-mortem.

Post-mortem

post-mortem is an examination of your baby's body. The examination can provide more information about why your baby died, which may be particularly important if you plan to become pregnant in the future.

A post-mortem can't go ahead without your written consent (permission), and you'll be asked if you want your baby to have one. The procedure can involve examining your baby's organs in detail, looking at blood and tissue samples, and carrying out genetic testing to see whether your baby had a genetic disease.

The healthcare professional asking for your consent should explain the different options to help you decide whether you want your baby to have a post-mortem.

Registering a stillbirth

By law, stillborn babies have to be formally registered. In England and Wales, this must be done within 42 days of your baby's birth, and in Scotland within 21 days.

In Northern Ireland, you don't have to register a stillbirth but you can if you want to, as long as it's within one year of the birth.

See the GOV.UK website for more information about registering a stillbirth

Follow-up

You'll usually have a follow-up appointment to check your health and discuss the post-mortem and test results (if carried out) a few weeks after you leave hospital.

This appointment is also an opportunity to talk with your doctor about possible future pregnancies. Before attending your follow-up appointment, you may find it helpful to write down any questions you have for your doctor.

Prevention

Not all stillbirths can be prevented. However, there are some things you can do to reduce your risk.

These include:

  • stopping smoking
  • avoiding alcohol and drugs during pregnancy – these can seriously affect your baby's development, as well as increasing the risk of miscarriage and stillbirth
  • attending all your antenatal appointments so that midwives can monitor the growth and wellbeing of your baby
  • making sure you're a healthy weight before trying to get pregnant
  • protecting yourself against infections (see causes of stillbirth) and avoiding certain foods
  • reporting any tummy pain or vaginal bleeding that you have to your midwife on the same day
  • being aware of your baby's movements and reporting any concerns you have to your midwife straight away
  • reporting any itching to your midwife

Some of these are discussed in more detail below. 

Your weight

Obesity increases the risk of stillbirth.

The best way to protect your health and your baby's wellbeing is to lose weight before becoming pregnant. By reaching a healthy weight, you cut your risk of all the problems associated with obesity in pregnancy.

If you're obese when you become pregnant, your midwife or GP can give you advice about improving your health while pregnant.

Eating healthily and activities such as walking and swimming are good for all pregnant women. However, if you weren't active before becoming pregnant, consult your midwife or doctor before starting a new exercise programme while you're pregnant.

Read more about pregnancy and healthy weight and exercise during pregnancy.

Monitoring your baby's movements

You'll usually start feeling some movement between weeks 16 and 20 of your pregnancy, although it can sometimes be later than this. These movements may be felt as a kick, flutter, swish or roll. 

The number of movements tends to increase until 32 weeks of pregnancy and then stay about the same, although the type of movement may change as you get nearer to your due date. You should continue to feel your baby move up to and during labour.

If you notice your baby is moving less than usual, or if you've noticed a change in the pattern of movements, it may be the first sign that your baby is unwell. You should contact your midwife or local maternity unit immediately so your baby's wellbeing can be assessed.

There's no specific number of movements that's considered to be normal. What's important is noticing and telling your midwife about any reduction or change in your baby's normal movements.

The Royal College of Obstetricians and Gynaecologists (RCOG) has produced a leaflet called Your baby's movements in pregnancy (PDF, 138kb) which you may find useful.

Avoiding certain foods

Some foods should be avoided during pregnancy. For example, you shouldn't eat some types of fish or cheese, and you should make sure that all meat and poultry is cooked thoroughly.

Read more about the foods to avoid during pregnancy

Attending antenatal appointments and reporting any concerns

During your antenatal appointments, your midwife or GP will monitor your baby's development. They'll monitor your baby's growth and position.

You'll also be offered tests, including blood pressure tests and urine tests. These are used to detect any illnesses or conditions, such as pre-eclampsia, that may cause complications for you or your baby. Any necessary treatment can be provided promptly and efficiently.

Support

A stillbirth can be emotionally traumatic for both parents as well as other family members. Help and support is available.

Many people experience feelings of guilt or anxiety following the loss of their baby. Some parents experience depression or post-traumatic stress disorder.

You may find it helpful to discuss your feelings with your GP, community midwife or health visitor, or with other parents who've lost a baby.

Support groups

Support groups can also help if you've had a stillbirth. Sands, the stillbirth and neonatal death charity, provide support for anyone affected by the death of a baby. The charity runs a helpline, provides information and support literature, and funds research into the causes of stillbirth.

You can call the confidential helpline on 020 7436 5881, or you can email. The helpline is open from 9.30am to 5.30pm, Monday to Friday. It's also open later on Tuesday and Thursday evenings, from 6pm to 10pm.

There are many other self-help groups in the UK for bereaved parents and their families. These support groups are usually run by healthcare professionals, such as baby loss support workers or specialist midwives, and parents who've experienced stillbirth.

Read more about bereavement and coping with grief